THE 


CARE  OF 

The  Eyes  and  Ears. 


BY 

RICHARD  H.  LEWIS,  M.  D., 

Member  of  the  State  Board  of  Health,  and  Surgeon  for  Diseases  of 
the  Eye,  Ear,  and  Throat  to  St.  John’s  Hospital,  and  to  that 
of  the  Leonard  Medical  School,  Raleigh,  N.  C. 


WILMINGTON,  N.  C. : 

PUBLISHED  BY  THE  NORTH  CAROLINA  BOARD  OF  HEALTH. 

1886. 


DIAGRAM  OF  THE  EYE  IN  HORIZONTAL  SECTION. 


S,  sclerotic  coat;  CH,  choroid  coat;  R,  retina,  or  nervous  coat,  continuous  with  ON,  the 
optic  nerve;  ML,  Macula  lutea,  or  yellow  spot,  the  centre  of  retina;  VH,  vitreous 
humor;  L,  lens;  AH,  aqueous  humor ;  I,  iris;  CM,  ciliary  muscle ;  C,  cornea;  Ca,  con¬ 
junctiva. 


Digitized  by  the  Internet  Archive 
in  2018  with  funding  from 
University  of  North  Carolina  at  Chapel  Hill 


\ 


https://archive.org/details/careofeyesearsOOIewi 


PREFACE. 


The  object  of  this  article,  prepared  at  the  request  of  the  State  Board 
of  Health,  is  to  assist,  as  far  as  may  be,  in  preserving  in  a  condition  of 
health  and  usefulness  the  most  important  of  the  senses. 

Eyesight  stands  easily  first  in  the  estimation  of  all,  and  Hearing  is 
only  second  to  it.  Blindness  being  one  of  the  most  frequent  causes 
of  pauperism,  it  becomes  still  more  the  duty  of  the  guardians  of  the 
public  health  to  present  to  the  people  such  information  as  may  help  to 
prevent  its  occurrence  than  a  regard  simply  for  the  happiness  and 
prosperity  of  the  individual  would  require.  But  there  are  so  many 
instances  of  damage  to,  and  loss  of,  one  or  the  other  of  these  precious 
senses  when  they  might  have  been  saved  by  the  knowledge  of  a  few  sim¬ 
ple  facts,  that  there  is  no  need  to  mention  the  relief  of  the  community 
of  a  pecuniary  burden  to  show  the  necessity  for  such  a  publication. 

This,  then,  being  intended  for  those  not  at  all  versed  in  medicine, 
must  be  as  free  as  possible  from  the  technicalities  in  which  the  profes¬ 
sional  man  is  accustomed  to  think,  and  at  the  same  time  as  brief  as 
possible  in  order  to  come,  together  with  other  necessary  publications, 
within  the  resources  of  the  Board  for  printing.  The  difficulties  of  the 
task  are  greatly  increased  by  these  conditions,  but  it  shall  be  my  en¬ 
deavor  to  be  as  plain  and  simple  as  possible,  and  at  the  same  time  as 
concise  as  a  regard  for  clearness  will  permit.  I  trust  the  kind  reader 
will  bear  these  facts  in  mind. 

217  N.  Wilmington  St.,  q 
Raleigh,  N.  C.,  May  12,  1886.  J 


5 


>- 
E 
< 
E 
C Q 

M 

on 

W 

-  <J 

I  2 

W 

g  0 

»  on 

3d 

E 

H 

< 

W 

X 


w 

E 

H 

U-, 

O 


< 

z 

NN 

J 

O 

E 

< 

U 

E 

H 

E 

O 

2 

u- 

O 

> 

H 

C/3 

E 

W 

> 

Z 

D 


LT\  VO 

on  t—  oo 
h  vo  co 

<  1  (— j  H 


C/3  U 

W  > 


<v 

c 

<c 

03 


s  * 

1 — »  ni  n 


U 
0) 
•  i-i 

rO 

3 

CO 

75 


Ti 

C3 

n» 


>« 

J 

53 

O 


0) 


<3 

O 

W 

ID 

Q 

.£3 


Ch 

QJ 


0)  O 

tn  r—t 

0)  <U 

J3  -D 


>> 

03 

T3 

03 

C/3 

H 

53 

U 

U 


T3 

<u 

03 

O 

TJ 

.3 

<i 

Q 


6 


o 


THE  CARE  OF  THE  EYES. 


In  order  to  understand  and  appreciate  instructions  as  to  the  proper 
method  of  caring  for  any  organ,  it  is  absolutely  necessary  to  have  some 
idea  of  the  nature  of  that  organ.  We  must  therefore,  before'  going 
farther,  study  for  a  few  minutes  the  structure  of  the  eye.  Reference 
to  the  diagram  in  front  will  assist  greatly  in  understanding  what  fol¬ 
lows. 

The  eye  is  a  nearly  round  ball  about  seven-eighths  of  an  inch  in 
diameter.  The  walls  of  the  posterior  five-sixths  of  this  globe  are  made 
up  of  three  thin  coats,  lying  one  immediately  upon  the  other  like  the 
layers  of  an  onion.  The  interior  of  this  part  is  filled  with  a  rather 
thick,  viscid,  but  perfectly  transparent  fluid  called  the  vitreous  humor. 
The  outermost  of  these  three  coats  or  layers  is  a  dense  opaque  mem¬ 
brane  named  the  sclerotic,  fibrous  in  structure,  something  like  the  ten¬ 
dons  or  “  leaders,”  and  therefore  very  strong  and  tough.  Its  purpose 
is  to  preserve  the  shape  of  the  ball  and  to  protect  the  more  delicate 
structures  within.  This  constitutes  “  the  white  of  the  eye.”  Next  to 
that  is  the  middle  coat,  or  choroid,  which  is  composed  of  a  network  of 
blood-vessels,  in  the  meshes  of  which  is  deposited  a  kind  of  dark  pig¬ 
ment  or  coloring-matter,  the  object  of  which  is  to  prevent  dazzling 
from  bright  light.  The  eyes  of  albinos  are  very  sensitive  to  light, 
owing  to  the  absence  of  this  coloring-matter  in  this  coat  as  well  as  in 
the  hair.  At  its  front  border  this  coat  is  thickened  by  the  addition  of 
another  element,  the  ciliary  muscle,  or  muscle  of  accommodation — a 
structure  of  great  interest  and  importance  to  us.  Interior  to  this  is 
the  third  and  innermost  layer,  called  the  retina.  It  may  for  our  pur¬ 
poses  be  considered  an  expansion  of  the  optic  nerve,  which,  coming 
from  the  brain,  perforates  the  first  two  coats  and  then  spreads  out  into 
this  nervous  layer,  “  like  the  cup  of  a  tulip  on  its  stem.”  This  is  the 
sensitive  plate  on  which  the  pictures  ot  all  objects  seen  are  taken. 

The  front  of  the  eyeball  is  quite  different  from  that  portion  we  have 
been  considering.  The  first  thing  we  notice  is  a  perfectly  transparent 
structure  (the  remaining  one-sixth  of  the  whole  ball),  which  appears 

7 


t 


8  THE  CARE  OF  THE  EYES  AND  EARS. 

to  be  part  of  a  smaller  globe,  and  which  seems  to  be  set  in  the  white 
of  the  eye  like  a  watch-crystal  in  its  rim.  This  is  the  cornea.  Just 
back  of  that  we  observe  a  very  beautiful  curtain,  which,  on  account  of 
its  infinite  variety  of  colors  in  different  individuals,  is  called  the  iris — 
that  word  meaning  a  rainbow.  Near  the  centre  of  this  curtain  is  a 
round  black  spot  which  is  often  referred  to  in  common  language  as  “  the 
sight  of  the  eye.”  This  is  merely  a  window  or  opening  in  the  curtain, 
the  pupil,  through  which  light  enters  the  eye  and  out  of  which  we  see. 
This  window  partially  opens  and  shuts  automatically  in  order  to  regu¬ 
late  the  amount  of  light.  The  space  between  the  iris  and  the  trans¬ 
parent  cornea  is  filled  with  a  watery  fluid,  the  aqueous  humor.  Imme¬ 
diately  behind  the  iris,  suspended  in  a  little  sac,  is  the  crystalline  lens. 
It  is  convex  or  bulging,  both  in  front  and  behind,  and  its  function  is 
to  make  pictures  on  the  retina  of  all  objects  before  the  eye. 

Covering  all  of  the  white  of  the  eye  that  can  be  seen,  and  leaping 
from  that  over  to  the  lids  and  lining  their  under  surfaces,  becoming 
continuous  with  the  skin  at  their  edges,  is  an  exceedingly  thin,  trans¬ 
parent  mucous  membrane  called  the  conjunctiva.  It  is  this  membrane 
which  is  involved  in  ordinary  simple  inflammations  of  the  eye.  It  is 
lubricated  by  tears  manufactured  for  the  purpose  by  the  lachrymal 
gland  at  the  upper  and  outer  corner,  the  surplus  being  carried  off  by 
two  little  gutters  in  the  inner  ends  of  the  two  lids  which  open  into  a 
larger  drain  emptying  into  the  nose.  Each  eye  is  moved  in  different 
directions  by  six  little  muscles,  but  the  only  ones  of  special  interest  to 
us  are  the  two  inner  straight  muscles,  that  are  attached  one  to  the  out¬ 
side  of  each  eye  next  the  nose,  which  converge  the  two  eyes  upon  near 
objects. 

For  the  sake  of  clearness  we  will  make  two  general  divisions  of  our 
subject,  and  consider  the  eye  first  in  its  relation  to  weak  sight ;  and 
secondly  in  its  relation  to  blindness,  although  they  will  overlap  one 
another  at  certain  points. 

Weak  Sight. 

Weak  sight  is  that  condition  of  affairs  in  which,  while  there  is  no 
evidence  of  disease,  the  eyes  are  nevertheless  unequal  to  the  perform¬ 
ance  of  their  legitimate  work.  The  acuteness  of  sight  for  ordinary 
distant  objects  is  sometimes  below  the  standard,  and  sometimes  not, 
but,  whether  it  be  or  not,  any  continuous  effort  at  near  work,  as  read¬ 
ing,  writing,  sewing,  etc.,  is  impossible,  and  always  brings  on  a  certain 
characteristic  group  of  symptoms.  First,  a  heavy,  tired  feeling  in  and 
around  the  eyes  is  observed,  and  then  the  letters  or  stitches  become 


THE  CARE  OF  THE  EYES. 


9 


indistinct.  After  &  rest  of  a  minute  or  two,  they  can  he  again  seen 
plainly,  only  to  become  blurred  even  more  and  in  a  shorter  time  than 
before.  A  repetition  of  these  attempts  causes  pain  and  watering  of  the 
eyes  with  redness  of  the  balls  and  edges  of  the  lids,  often  headache,  and, 
in  some  cases,  a  disturbance  of  the  general  health,  more  especially  the 
nervous  functions.  If  attended  to  promptly,  it  can  nearly  always  be  easily 
relieved ;  but  if  it  be  neglected  and  nothing  done  for  it,  perseverance  in 
near  work  is  liable  to  cause  such  sensitiveness  and  irritability  of  the 
eyes  as  to  render  them  not  only  practically  useless,  but  a  constant 
source  of  annoyance  and  discomfort  in  the  ordinary  lights  we  must 
daily  encounter.  It  is  exceedingly  common  (and  through  heredity 
becoming  more  so  every  day),  and,  while  not  productive  of  blindness, 
interferes  seriously  with  the  practical  use  of  the  eyes,  as  we  have  just 
said.  It  is,  moreover,  very  often  met  with  in  the  young  during  school- 
life,  when  it  prevents  their  studying  with  ease  and  comfort,  if  they  can 
at  all,  and  by  so  doing  obstructs  the  formation  of  the  habit  of  study, 
which  in  the  average  boy  demands  every  encouragement,  thereby  affect¬ 
ing  injuriously  the  character,  probably  for  life.  Such  being  the  case, 
and  the  remedy  for  these  troubles  being  very  simple  and  easily  applied 
when  once  they  are  recognized  and  their  true  nature  appreciated,  the 
Board  of  Health  regards  it  as  of  prime  importance  +hat  the  public 
should  be  put  in  a  position  to  recognize  and  appreciate  them. 

Advice  to  intelligent  people  is  much  more  apt  to  be  taken  if  accom¬ 
panied  by  the  reasons  for  it,  and  they  are,  besides,  much  more  likely  to 
be  interested  in  a  subject  if  it  can  be  explained  and  made  clear  than 
they  would  be  in  a  mere  didactic  statement  of  bald,  unillustrated  facts. 
Therefore,  as  interest  in  these  important  matters  on  the  part  of  the  peo¬ 
ple  is  what  the  Board  is  especially  anxious  to  create,  I  shall  endeavor 
to  elucidate  the  subject  in  as  simple  a  manner  as  possible. 

Weak  sight — asthenopia,  as  it  is  technically  called — is  sometimes  due  to 
a  weak  and  irritable  condition  of  the  nervous  apparatus  of  the  eye  pure 
and  simple  ;  and  this  form  occurs  most  frequently  in  young  women,  who 
are  peculiarly  prone  to  functional  nervous  disturbances.  But  in  a  vast 
majority  of  instances  it  is  caused  by  an  overstrain  of  the  muscles  of  the 
eye,  either  those  which  adjust  each  eye  for  objects  at  different  distances, 
or  those  which  turn  both  eyes  in  upon  near  objects.  This  overstrain 
may  be,  and  sometimes  is,  due  to  simple  weakness  of  these  muscles,  as 
often  occurs  during  convalescence  from  severe  attacks  of  illness,  in  which 
cases  it  is  only  temporary ;  but  it  is  nearly  always  a  consequence  of  the 
faulty  shape  of  the  ball,  causing  certain  optical  defects  or  errors  in  re¬ 
fraction,  as  they  are  usually  called. 


10 


THE  CARE  OF  THE  EYES  AND  EARS. 


In  order  to  understand  these  optical  defects  it  is  necessary  to  first 
understand  what  is  a  correct  eye,  and  how  we  see  with  it.  The  know¬ 
ledge  of  a  few  facts  in  regard  to  the  nature  of  a  convex  lens  will  render 
this  easy. 

A  convex  lens  is  a  body  of  some  transparent  material,  usually  glass 
as  we  see  it,  flattened  from  side  to  side,  thicker  in  the  middle  than  at 
the  edges,  with  its  faces  having  the  curvature  of  part  of  a  sphere  or 
round  ball.  A  familiar  example  is  an  ordinary  magnifying-  or  sun¬ 
glass.  Its  peculiar  property  is  that  rays  of  light  emanating  from  any 
object,  after  passing  through  it,  are  brought  together  again  in  the  same 
relation  to  one  another  as  they  started  from  the  object,  and  a  picture 
or  image  of  it  is  thereby  produced.  The  point  at  which  this  union  is 
effected  is  called  the  focus  of  the  lens.  The  more  convex  the  lens,  the 
stronger  it  is  and  the  shorter  is  its  focus.  The  action  of  a  convex  lens 
can  be  interestingly  illustrated  in  this  way :  Having  closed  all  the 
doors  and  windows  of  the  room  except  one  in  order  to  shut  off  the 
side  lights,  take  a  magnifying-glass — or,  if  not  convenient,  the  spec¬ 
tacles  of  the  oldest  person  in  the  house,  they  being  convex  lenses — 
and,  holding  it  immediately  opposite  the  window  about  three  feet  from 
the  wall,  gradually  approach  it  thereto,  and  you  will  presently  see 
come  out  on  the  wall  a  distinct  picture,  turned  upside  down,  of  the  sky, 
trees,  and  other  objects  outside. 

If  you  will  turn  to  the  diagram  of  the  eye,  you  will  recall  that  the  lens 
is  situated  immediately  behind  the  iris  and  opposite  the  pupil,  and  that 
the  sensitive  retina  is  the  coat  nearest  to  it,  being  the  innermost  of  the 
three.  Now,  as  the  convex  lens  of  glass  held  opposite  the  window  of 
the  darkened  room  makes  a  picture  of  outside  objects  on  the  wall,  just 
so  does  the  convex  lens  in  the  dark  chamber  of  the  eye  placed  opposite 
the  only  window,  the  pupil,  make  a  picture  of  outside  objects  on  the 
retina,  which  in  the  normal  eye  is  exactly  at  its  focus.  The  impression 
thus  made  upon  the  retina  is  transmitted  to  the  brain  by  the  optic  nerve, 
and  the  act  of  vision  is  complete. 

In  what  has  been  said  about  rays  of  light  reference  has  been  had 
only  to  rays  from  distant  objects,  which  are  always  practically  parallel 
to  one  another.  It  is  an  optical  fact  that  rays  emanating  from  objects 
nearer  than  twenty  feet  sensibly  diverge  from  one  another,  and  that  the 
nearer  the  object  the  more  divergent  they  are.  A  lens  having  only  so 
much  power  to  concentrate  light,  it  is  evident  that  divergent  rays  can¬ 
not  be  brought  to  a  focus  as  soon  as  parallel ;  in  other  words,  that  their 
focus  must  be  farther  from  the  lens.  This  being  true,  how  is  it  that  we 
see  near  objects  distinctly,  as  the  retina  cannot  be  set  back  to  this  new 


THE  CAEE  OF  THE  EYES. 


11 


focus  ?  By  an  increase  in  the  thickness  or  convexity  of  the  lens,  which, 
as  you  remember,  shortens  the  focus.  This  is  what  is  called  the  accom¬ 
modation  of  the  eye,  and  it  is  effected  in  the  following  manner :  The 
inherent  tendency  of  the  lens-substance,  which  is  exceedingly  elastic,  is 
to  assume  a  more  globular  form,  but,  enclosed  in  a  sac,  it  is  suspended 
or  swung  in  the  larger  concentric  circle  made  by  the  ciliary  muscle  by 
means  of  a  connecting  band  (see  diagram),  and  as  long  as  the  muscle 
is  at  rest  the  sac  is  kept  upon  the  stretch  and  the  lens  more  or  less 
flattened.  As  soon,  however,  as  the  muscle  contracts,  being  a  ring, 
it  must  become  smaller,  and  in  so  doing  necessarily  slacks  the  sac, 
thereby  allowing  the  lens  to  follow  its  natural  bent  and  bulge  more  in 
the  middle.  This  is  clearly  shown  in  Fig.  1,  where  one  half  represents 


Fig.  1. 


the  position  of  the  parts  when  the  eye  is  at  rest  or  adjusted  for  dis¬ 
tance,  and  the  other  half  when  the  muscle  has  contracted  and  it  is 
adjusted  for  near  objects.  It  will  be  observed  that  the  edge  of  the 
lens  is  nearer  to  the  muscle  in  the  latter,  and  that  therefore  the  sus¬ 
pensory  ligament  or  band  must  be  slacked. 

In  this  way  each  separate  eye  is  accommodated  for  different  distances, 
but,  as  we  always  use  the  two  eyes  together,  the  adjustment  is  not  com¬ 
plete  unless  they  are  both  fixed  upon  the  object.  This  convergence  is 
made  by  the  inner  straight  muscles  attached  to  the  sides  of  the  balls 
next  the  nose,  and  the  nearer  the  object  of  course  the  more  must  the 

eyes  be  turned  in.  . 

Thus  we  see  that  the  adjustment  of  the  eyes  for  near  objects  is 

accomplished  by  a  muscular  effort  on  the  part  of  two  sets  of  muscles, 
and  that  the  nearer  the  object  the  greater  the  effort  required  of  both, 
so  that  there  is  always  a  harmony  of  action  between  the  two.  If  you 
will  look  steadily  at  a  pencil  or  your  finger  held  less  than  six  inches 


12 


THE  CARE  OF  THE  EYES  AND  EARS. 


from  the  eyes,  you  will  be  distinctly  conscious  of  this  effort,  which  if 
kept  up  becomes  painful ;  but  at  the  ordinary  distance  of  ten  or  twelve 
inches  it  is  not  perceptible  in  eyes  of  the  proper  shape.  But  variations 
from  this  proper  shape  are  exceedingly  frequent,  and,  as  said  before, 
defects  in  form  are  nearly  always  at  the  bottom  of  weak  sight.  They 
are  of  three  kinds.  In  Fig.  2  the  line  X  Y  represents  the  retina  in  a 


Fig.  2. 


normal  eye  at  the  proper  distance  from  the  lens,  but  the  eye  may  be 
too  short,  with  the  retina  too  close  to  the  lens,  A  B,  causing  over-sight  or 
far-sight ;  or  it  may  be  too  long,  with  the  retina  too  far  from  the  lens, 
M  N,  causing  near-sight  or  myopia;  or  the  clear  front,  the  cornea,  may 
be  irregular  in  its  curvature,  producing  what,  for  want  of  a  common 
name,  will  have  to  be  called  by  the  technical  term  of  astigmatism.  An 
easy  way  to  remember  these  errors  is  to  bear  in  mind  that  the  short 
eye  has  long  sight,  and  the  long  eye  short  sight,  while  the  astigmatic 
eye  does  not  have  good  sight  at  any  distance. 

Oversight  or  Far-sight  is  by  long  odds  the  most  common  of  these 
optical  defects,  certainly  in  this  country,  and  it  is  therefore  the  most 
frequent  cause  of  weak  sight.  But  how  does  it  cause  weak  sight  ?  you 
will  ask.  By  adding  to  the  strain  upon  the  accommodation.  In  the 
normal  eye,  the  retina  being  exactly  at  the  focus  of  parallel  rays  (X  Y, 
Fig.  2),  no  effort  whatever  is  required  for  distant  vision,  and  the  accom¬ 
modation  for  near  objects  can  be  made  without  trouble;  but  in  the 
short  eye  (A  B)  the  focus  must  be  shortened  even  for  distance,  and  con¬ 
sequently  just  that  much  work  must  be  added  to  what  is  usually  re¬ 
quired  of  the  little  muscle ;  and  that  is  too  much  for  it,  so  it  breaks 
down,  and  we  have  precisely  what  we  would  expect  from  muscular 
fatigue — viz.  the  sense  of  weariness  and  heaviness  about  the  eyes,  the 
recurring  dimness  of  the  letters,  the  aching,  and  other  symptoms  cha¬ 
racteristic  of  weak  sight.  Therefore,  upon  the  occurrence  of  these 
symptoms  we  would  suspect  the  presence  of  over-sight,  especially  if 


THE  CARE  OF  THE  EYES. 


13 


distant  vision  were  perfect  (which  would  exclude  near-sight  and  astig¬ 
matism),  although  it  is  not  perfect  in  the  highest  degrees  of  over-sight 
itself,  because  in  them  the  ball  is  so  very  short  that  it  is  beyond  the 
power  of  the  muscle  to  bring  up  the  focus  of  even  parallel  rays  to  the 
retina.  Such  cases,  however,  are  comparatively  rare.  Another  effect 
of  this  over-sight  is  that  the  harmony  of  action  between  the  two  sets  of 
muscles  used  in  adjusting  the  eyes,  accommodation  and  convergence,  is 
destroyed,  and  as  a  result  we  frequently  have  crossed  eyes,  this  being 
the  cause  in  over  75  per  cent,  of  such  cases. 

•  The  remedy  is  simple  and — if  applied  early  before  the  eyes  become 
chronically  irritable — sure.  Everything  necessary  to  be  done  is  to 
shorten  the  focus  of  the  lens  in  proportion  to  the  shortness  of  the  eye, 
so  as  to  do  away  with  all  extra  effort — that  is,  all  effort  for  distance — 
and  put  the  eye  on  an  equality  with  the  normal  eye.  This  is  easily 
done  by  adding  on  another  convex  lens  of  the  proper  strength  in  the 
shape  of  spectacles. 

Near-sight  or  Myopia  is  a  subject  of  peculiar  interest  to  the  custo¬ 
dians  of  the  public  health.  It  is  just  the  opposite,  optically,  of  far¬ 
sight  or  over-sight,  and,  while  the  conditions  causing  the  latter  are 
always  congenital,  in  near-sight  they  originate,  as  a  large  number  of 
investigations  show  conclusively,  between  the  ages  of  six  and  sixteen, 
or  during  school-life — rarely  before  and  rarely  after  that  period* 
Heredity  exerts  a  powerful  influence  in  its  production,  a  considerable 
proportion  of  the  children  of  one  near-sighted  parent  being  apt  to 
develop  it,  but  it  is  very  often  acquired  when  there  is  no  predisposition 
to  it.  When  once  established  it  is  incurable.  It  can  to  a  large  extent 
he  prevented  by  proper  care  on  the  part  of  parents  and  teachers  during 
the  period  named.  I  shall  therefore,  as  the  representative  of  the  Board 
of  Health  in  this  matter,  endeavor  to  set  forth  clearly  the  true  cha- 

*  It  appears  from  the  German  statistics  that  the  percentage  of  myopia, 
beginning  with  less  than  one  half  of  1  per  cent,  during  the  first  half  year 
of  school-life,  increased  gradually  from  year  to  year  to  over  60  per  cent,  on 
an  average  in  the  highest  class,  in  one  instance  going  as  high  as  79  percent. 
The  Germans,  however,  are  a  peculiarly  near-sighted  race,  and  in  this 
country  the  percentage  of  short-sight  is  only  about  half  as  great.  An  in¬ 
teresting  result  of  the  American  observations  is  the  fact  that  myopia  is  very 
rare  among  the  negroes ;  all  of  which  demonstrates  in  a  general  way  the 
influence  of  literary  culture  and  of  heredity  in  the  causation  pf  this  trouble. 
The  investigations  further  show  that  the  development  of  near-sightedness 
is  in  a  direct  ratio  to  the  prevalence  of  the  unfavorable  conditions  referred 
to  in  the  text,  and  that  it  increases  in  degree,  after  it  has  once  started,  from 
year  to  year. 


14 


THE  CARE  OF  THE  EYES  AND  EARS. 


racter  of  the  affection,  with  the  means  of  its  prevention,  in  order  to 
save  our  people  as  far  as  possible  from  becoming  any  more  “  bespec¬ 
tacled  ”  than  is  absolutely  necessary. 

As  mentioned  above,  near-sight  is  due  to  an  elongation  of  the  eye¬ 
ball  displacing  the  retina  backward,  so  that  parallel  rays  come  to  a 
focus  in  front  of  it,  and  only  divergent  rays — from  near  objects — come 
to  a  focus  exactly  on  it,  and  they  only,  therefore,  can  be  distinctly 
seen  ;  so  that  the  causes  of  short-sight  are  to  be  found  in  everything 
that  has  a  tendency  to  increase  the  length  of  the  ball. 

Merely  mentioning  the  fact  that  anything  injurious  to  the  general 
health,  by  weakening  the  resisting  power  of  the  tissues  of  the  eye  in 
common  with  those  of  the  rest  of  the  body,  assists  in  producing  this 
elongation,  and  calling  attention  especially  to  the  execrable  ventilation 
of  many  school-rooms  as  a  most  active  agency  in  this  category,  I  will 
point  you  particularly  to  those  causes  acting  directly  through  the  eye 
itself. 

It  is  now  regarded  as  an  established  fact  that  the  continued  tension 
of  the  muscles  of  adjustment  (accommodation  and  convergence)  is  the 
principal  factor  in  the  production  of  near-sight ;  and,  it  having  been 
explained  above  that  the  nearer  the  object  to  the  eyes  the  greater  the 
tension  or  strain  upon  both  these  sets  of  muscles,  it  follows  that  every¬ 
thing  having  a  tendency  to  cause  the  undue  approximation  of  objects 
on  which  the  eyes  are  continuously  used  during  childhood  assists  in 
the  origination  of  this  condition.  I  say  “  in  childhood,”  because,  as 
we  have  seen,  it  nearly  always  begins  during  that  period ;  and  it  does 
so  for  the  reason  that  the  tissues  of  all  growing  and  immature  animals 
are  more  soft  and  yielding  than  when  they  have  attained  the  firmness 
of  maturity — another  reason  for  special  attention  to  their  general  health 
at  this  time. 

Since  a  large  part  of  childhood,  and  particularly  that  part  of  it  in 
wdiich  the  eyes  are  used  most  on  near  objects,  is  passed  in  the  school¬ 
room,  it  is  there  that  we  would  naturally  seek  the  causes  of  this  trouble. 
And  it  is  there  that  they  are  generally  found.  School-children  are 
often  compelled  to  hold  their  books  too  near — that  is,  nearer  than  ten 
inches — because  the  amount  of  light  is  insufficient.  This  question  of 
plenty  of  light  of  good  quality  (the  best  is  direct  from  a  northern  sky) 
in  the  school-room  is  of  the  highest  importance,  and  cannot  be  im¬ 
pressed  too  deeply  upon  those  having  such  matters  in  charge.  In  a 
general  way,  it  may  be  said  that  there  should  always  be  enough  light 
to  enable  a  child  to  read  on  a  moderately  clear  day  fine  print  in  the 
darkest  corner  of  the  room  at  the  distance  of  a  foot.  And  the  direc- 


THE  CARE  OF  THE  EYES. 


15 


tion  from  which  it  comes  is  also  important.  Preferably,  it  should  come 
from  the  left  and  above,  so  that,  while  illuminating  the  page,  it  may 
not  fall  upon  the  eyes  nor  cast  a  shadow  of  the  hand  in  writing.  The 
next  best  direction  is  from  behind,  then  from  the  right,  but  never  from 
in  fiont.  The  children  should  always  look  at  a  dead  wall.  I  append 
an  admirable  statement  of  the  “  Requirements  of  the  Model  School¬ 
room,”*  copied  in  the  Sanitarian  for  October,  1885,  from  City  School 
Systems  of  the  United  States,  and  earnestly  commend  it  to  all  school 
boards  and  others  having  in  charge  the  building  of  school-houses.  It 

*  “Requirements  of  the  Model  School-room. 

“(1)  Shape. — It  should  be  oblong,  the  width  being  to  the  length  about  as 
three  to  four,  with  the  teacher’s  platform  at  one  end. 

“(2)  Size. — For  primary  or  grammar  school,  with  register  of  54  pupils  and 
attendance  of  about  50,  the  room  should  be  about  33  feet  long,  25  wide,  and 
13  high,  which  gives  practically  upward  of  200  cubic  feet  of  air  and  16£  square 
feet  of  floor-space  to  each  pupil. 

“(3)  Lighting. — Four  windows  on  the  left  of  the  pupils  as  they  sit,  the  tops 
being  square  and  not  more  than  six  inches  from  the  ceiling,  the  bottoms 
being  at  least  three  and  a  half  feet  from  the  floor,  equally  spaced,  not 
grouped,  with  transom  sashes  hung  at  the  base  above  the  sliding  sashes.  A 
window  or  two  in  addition  at  the  back  is  admissible.  The  size  of  tjie  win¬ 
dows  on  the  side,  taken  collectively,  should  equal  at  least  one-sixth  of  the 
floor-space.  The  highest  authorities  in  school  hygiene  require  300  or  350 
square  inches  of  glass  for  each  pupil. 

“(4)  On  the  side  opposite  the  windows  two  doors,  with  transom  windows 
above  hung  at  the  base,  and  between  these  transom  windows,  and  on  the 
same  line,  two  more  windows  of  the  same  kind  and  hung  in  the  same 
manner. 

“(5)  The  wall  should  be  slightly  tinted,  but  not  the  ceiling. 

“(6)  A  black-board  may  be  between  the  doors,  but  a  sliding  black-board 
back  of  the  teacher’s  platform,  or  a  portable  one  on  the  platform,  in  accord¬ 
ance  with  the  German  idea,  would  perhaps  be  better  than  the  profusion  of 
wall  black-board  now  in  vogue  among  us. 

“(7)  Location  of  Seats—  The  main  rule  to  be  observed  in  the  placing  of  the 
seats  is  to  carry  them  as  far  as  possible  toward  the  window  side  of  the  room, 
and  as  far  as  possible  from  the  opposite  side;  the  aim  being  to  make  the 
arrangement  such  that  the  distance  of  the  outer  row  of  desks  from  the 
windows  shall  not  exceed  once  and  a  half  the  height  of  the  top  window 
from  the  floor.” 

Proper  height  of  seats  and  desks  for  different  ages,  as  approved  by  the 
Boards  of  Health  of  New  York  and  Chicago  : 

From  7  to  9  years,  top  of  desk  23  inches,  front  of  seat  12£  inches. 


9  to  11  “ 

u 

“  24  “ 

« 

“  12| 

12  to  14  “ 

u 

“  25f  “ 

tt 

“  14 

15  to  18  “ 

It 

“  27^  “ 

It 

“  151 

16 


THE  CARE  OF  THE  EYES  AND  EARS. 


need  not  be  more  expensive  than  the  ordinary  plan,  except  in  the 
matter  of  windows ;  and  I  am  sure  no  one  will  grudge  the  children 
under  his  care  in  this  respect  the  very  slight  additional  cost  necessary 
to  supply  them  with  light  enough  for  the  comfortable  and  safe  use  of 
their  eyes. 

The  light  being  sufficient,  the  print  may  be  bad  or  too  small,  though 
this  danger  has  now  been  largely  eliminated  by  the  spread  of  know¬ 
ledge  on  this  subject  and  the  active  competition  of  publishers. 

Sometimes  the  proportion  between  the  height  of  the  seat  and  that 
of  the  desk  is  such  as  to  bring  the  book  too  near,  as  a  low  seat  with  a 
high  desk. 

Occasionally  the  seat  has  no  back,  so  that  from  sheer  fatigue  the 
child  is  constrained  to  lean  forward  on  the  desk  to  rest  himself. 

Any  of  these  things  may  cause  this  dangerous  approximation,  and 
not  infrequently  it  is  made  more  hurtful  by  a  system  of  instruction 
which  requires  it  to  be  kept  up  continuously  for  hours  at  a  time. 

The  approximation  of  the  book  to  too  near  a  point  is  dangerous, 
because,  as  we  have  seen,  it  necessitates  a  strain  upon  the  muscles  of 
adjustment.  That  strain  excites  an  increased  flow  of  blood  to  the  eyes 
to  furnish  the  power  for  the  extra  work.  The  increased  amount  of 
blood  causes  dilatation  of  the  blood-vessels  and  congestion,  which  con¬ 
duces  to  the  softening  and  degeneration  of  the  coats,  especially  of  the 
outer,  tough,  white  coat,  wffiose  peculiar  function  is  to  preserve  the 
shape  of  the  ball.  At  the  same  time  it  has  a  tendency  to  augment  the 
volume  of  the  humors  within  the  eye.  This  increase  in  the  humors 
adds  to  the  pressure  from  within  outward,  causing  the  softened  coats 
to  give  way  or  bulge  slightly  at  their  weakest  point,  which  is  at  the 
back,  around  the  entrance  of  the  optic  nerve.  But  the  principal  factor, 
probably,  in  the  production  of  the  bulging  is  the  squeezing  of  the  ball 
by  the  muscles  which  move  it,  as  they  are  put  greatly  upon  the  stretch 
when  the  eyes  are  turned  in  much.  The  walls,  having  once  begun  to 
give  way,  become  thinner  and  less  able  to  resist,  and,  the  same  causes 
continuing  to  act,  the  near-sight  is  apt  to  increase.  If  the  bulging 
extend  beyond  a  certain  point,  the  two  inner  and  more  delicate  coats 
become  very  much  damaged,  and  sometimes  destroyed,  by  the  excessive 
stretching.  Occasionally  the  retina,  unable  to  follow  farther,  is  de¬ 
tached  from  the  coat  lying  under  it,  and  then  total  destruction  of  sight 
is  only  a  matter  of  time.  So  that  short-sight  is  nearly  always  accom¬ 
panied  by  a  diseased  condition ,  often  progressive  in  character,  that 
may,  and  not  infrequently  does,  end  in  blindness,  making  our  duty  to 
give  warning  of  its  dangers  the  more  imperative. 


THE  CARE  OF  THE  EYES. 


17 


It  is  the  duty  of  the  teacher  to  see  to  it  that  the  faulty  conditions  as 
to  light,  etc.  above  indicated  are  corrected,  so  far  as  lies  in  his  power. 
He  should,  besides,  make  it  a  point  to  frequently  interrupt  the  studies 
by  various  appropriate  exercises  (now  common  in  well-managed  schools) 
which  will  permit  a  rest  of  the  eyes,  and  by  frequent  recesses.  Parents 
also  should  exercise  supervision  in  these  matters  at  home,  and  in 
addition  to  carrying  out  the  instructions  given  under  the  head  of 
“  General  Directions,”  they  should  forbid  too  much  study  and  reading, 
especially  if  their  children  be  precocious  and  disposed  to  be  bookish, 
and  encourage  them  to  outdoor  life.  This  is  often  the. more  urgent  be¬ 
cause  such  children  are  apt  to  be  feeble  and  delicate  in  constitution. 

Owing  to  the  presence  of  disease  in  so  many  near-sighted  eyes,  they 
are  very  often  sensitive,  irritable,  and  painful.  The  ordinary  symptoms 
of  weak-sight  too  are  frequently  complained  of,  even  when  the  morbid 
changes  are  not  very  marked,  they  being  due  to  the  overstrain  of  the 
muscles  of  convergence,  caused  by  the  necessity  of  holding  the  book 
too  near  in  order  to  make  out  the  letters. 

Attention  to  the  presence  of  this  defect  will  most  likely  be  called  by 
the  child’s  inability  to  read  figures  on  the  black-board  or  in  some  similar 
way.  Either  a  high  degree  of  over-sight  or  the  irregular  error,  astig¬ 
matism,  may  cause  this  as  well  as  short-sight,  but  the  difference  between 
them  and  the  true  myopia  is  that  in  the  last  the  sight  for  objects  held 
near  enough  is  generally  unusually  acute,  while  in  the  first  two  it  is  apt 
to  be  more  or  less  proportionally  bad  at  all  distances. 

When  once  the  fact  becomes  known,  the  eyes  should  be  scrupulously 
guarded,  and  upon  any  complaint  (or  without  waiting  for  it  if  the  child 
seems  to  be  very  near-sighted)  the  advice  of  a  competent  physician 
should  be  promptly  sought,  so  that  he  may  give  fully  and  explicitly 
the  proper  directions  for  the  treatment  and  care  of  the  eyes,  including, 
if  the  state  of  the  case  warrant  them,  the  proper  concave  glasses.  Con¬ 
cave  glasses,  being  the  reverse  of  convex,  lengthen  the  focus  to  suit  the 
(short-sighted)  long  eye.  It  is  of  peculiar  importance  that  accurately- 
adjusted  glasses  should  be  worn  in  these  cases,  because  they  not  only 
permit  the  removal  of  the  book  to  a  safe  distance,  theieby  assisting 
greatly  in  checking  the  progress  of  the  affection,  but  they  also  enable 
the  child  to  imbibe  unconsciously  a  vast  amount  of  knowledge  that 
would  otherwise  escape  him.  At  the  same  time,  being  in  a  position 
to  see  and  enjoy  the  world  around  him,  he  would  be  encouraged  to 
use  them  on  distant  objects  and  get  away  from  his  books. 

Astigmatism. — The  explanation  of  this  error  is  apt  to  be  so  confus- 
ing  to  any  one  not  quite  familiar  with  optics  that  I  shall  not  weary 

2 


18 


THE  CARE  OF  THE  EYES  AND  EARS. 


you,  but  will  merely  mention  certain  characteristic  facts.  The  astig¬ 
matic  person  sees  neither  distant  nor  near  objects  distinctly,  but  he  has 
the  peculiarity  of  seeing  lines  running  in  one  direction  more  clearly 
than  others  at  right  angles  to  them,  and  these  lines  are  usually  vertical 
and  horizontal.  He  is  apt  to  complain  of  all  the  symptoms  of  weak 
sight,  probably  in  an  exaggerated  form,  with  an  unusual  amount  of 
headache,  and  sometimes  other  nervous  symptoms.  Glasses  accurately 
calculated,  and  made  (as  they  must  be)  for  the  j)articular  individual, 
render  the  sight  acute,  and  are  often  of  unspeakable  comfort. 

Old  Sight  cannot  be  considered,  strictly  speaking,  as  an  optical 
defect,  but  it  is  merely  one  of  the  changes  which  come  to  us  all  with  age. 
The  lens  of  the  eye  becomes  stiff  and  hard,  less  elastic  than  in  our 
younger  days,  and  consequently  when  the  muscle  of  accommodation, 
which  has  also  lost  some  of  its  vigor,  slacks  the  sac  holding  it,  it  does 
not  assume  the  convexity  necessary  for  distinct  vision  of  near  objects. 
At  the  same  time,  distant  vision  remains  as  good  as  ever,  because,  as 
you  remember,  no  adjustment  is  needed  in  the  normal  eye  for  distance. 
It  usually  makes  its  appearance  between  forty  and  fifty  years  of  age. 
The  first  symptom  is  a  disposition  to  hold  the  book  or  paper  rather 
farther  off  or  to  seek  a  better  light,  especially  at  night.  After  a  little 
the  symptoms  of  weak  sight  come  on,  and  for  the  same  reason  that  they 
usually  appear — viz.  overstrain  of  the  muscle,  though  this  time  it  is  not 
due  to  the  shape  of  the  ball,  but  the  consistence  of  the  lens.  The 
remedy  is  found  in  convex  glasses,  which  by  shortening  the  focus  assist 
the  accommodation  and  relieve  the  strain.  It  is  very  important  to  put 
on  glasses  as  soon  as  needed,  to  avoid  this  strain,  not  only  as  a  matter 
of  comfort,  but  because  the  overstraining  of  old  eyes  is  thought  to  be 
one  of  the  causes  of  a  most  serious  and  fatal  disease  of  the  eye. 

Recapitulation. 

In  the  preceding  pages  an  attempt  has  been  made  to  set  forth,  as 
simply  and  clearly  as  possible,  certain  facts  of  general  interest  and 
importance  in  regard  to  the  eye,  especially  those  bearing  upon  the 
exceedingly  common  and  troublesome  group  of  symptoms  included 
under  the  general  term  “  weak  sight,”  and  upon  the  nature  and  dan¬ 
gers  of  near-sight.  The  subject  has  been  dwelt  upon — to  the  point  of 
tediousness,  some  will  feel,  I  fear — because,  while  of  very  frequent 
occurrence,  and  when  present  very  annoying,  even  to  the  extent  of 
rendering  the  eyes  practically  useless,  the  nature  of  weak  sight  is  not 
at  all  understood  by  most  people,  nor  are  they  aware  that  it  can  in 
most  cases  be  conqfietely  relieved  by  a  very  simple  remedy.  Neither 


THE  CARE  OF  THE  EYES. 


19 


is  it  generally  known  that  near-sight,  often  the  result  of  preventable 
causes,  is  frequently  associated  with  disease  that  may  prove  fatal  to 
vision,  and  that  special  care  is  therefore  required  in  its  management. 
On  the  contrary,  the  popular  opinion  is  that  near-sighted  eyes  are 
strong  eyes. 

It  has  been  shown  that  in  the  normal  eye  objects  are  seen  by  the 
formation  of  images  or  pictures  of  them  through  the  instrumentality 
of  the  lens  on  the  sensitive  retina;  that  distant  objects  are  seen  clearly 
without  effort,  while  near  objects  are  made  distinct,  by  a  muscular  effort, 
it  is  true — the  accommodation — but  one  that  can  be  made  and  kept  up 
without  fatigue ;  and  that  the  two  eyes  are  held  upon  near  objects  com¬ 
fortably  by  the  muscles  of  convergence.  It  has  also  been  explained 
how  certain  departures  from  the  normal  in  the  shape  of  the  eyeball 
will  bring  about  an  overstrain  of  one  or  both  of  these  sets  of  muscles, 
causing  weak  sight,  Attention  was  called  to  the  short  eye,  causing 
over-sight  or  long-sight,  as  by  odds  the  most  frequent  cause  of  weak 
sight,  though  certain  nervous  conditions,  weakness  of  the  muscles  from 
sickness,  and  strain  of  the  muscles  of  convergence  in  short-sight,  were 
mentioned  as  being  sometimes  responsible  for  it.  It  has  been  further 
made  plain  that  near-sight,  or  myopia,  is  the  result  of  an  elongation 
backward  of  the  globe ;  that  it  nearly  always  originates  during  school- 
life  or  between  the  ages  of  six  and  sixteen  ;  that  it  is  often  progressive 
in  character,  and  is  then  associated  with  diseased  conditions  which  may 
lead  to  total  loss  of  sight ;  that  its  cause  is  too  great  tension  or  strain 
of  the  muscles  of  adjustment,  resulting  from  too  much  study  or  from 
unfavorable  surroundings,  necessitating  an  overstrain  by  requiring  too 
near  an  approximation  of  the  object ;  and,  finally,  that  it  is  largely 
preventable  by  proper  care. 

General  Directions. 

The  directions  for  the  proper  use  of  the  eyes  follow,  almost  as  a  mat¬ 
ter  of  course,  from  what  has  been  said. 

Always  have  plenty  of  light.  Economy  in  light  is  very  poor  economy. 
Many  of  the  most  intractable  forms  of  weak  sight  I  have  seen  have  re¬ 
sulted  from  the  use  of  the  eyes  by  a  bad  and  insufficient  light.  Any 
good,  white,  steady  light  will  answer,  provided  it  is  bright  enough.  The 
German  student’s  lamp,  looked  at  from  every  point  of  view,  expense 
included,  is  probably  the  best  light,  but  any  good  lamp  with  a  large 
wick,  that  is  kept  clean  and  well-trimmed  and  filled  with  good  oil,  will 
do  very  well.  Avoid  flickering  gas-jets.  If  you  prefer  gas,  see  that 
the  flame  is  steadied  by  an  argand  burner  or  a  transparent  globe  with 


20 


THE  CARE  OF  THE  EYES  AND  EARS. 


a  large  opening  below.  The  light  should  come  from  behind  and  the 
left,  so  as  to  illuminate  the  page  and  not  the  eyes.  Nothing  is  more 
irritating  than  a  number  of  lights  falling  upon  the  eyes  from  different 
directions,  as  the  jets  in  a  church  or  public  hall,  and  those  with  sensi¬ 
tive  eyes  should  never  attend  such  places  at  night  without  the  protection 
either  of  dark  glasses  or  a  shade. 

Never  read  by  twilight.  I  have  in  mind  now  a  young  lady  of 
prominence  who,  for  one  imprudence  in  this  respect,  forfeited  the 
use  of  her  eyes  for  months,  not  to  mention  the  positive  suffering  she 
endured. 

Do  not  read  lying  down.  Owing  to  the  position,  the  eyes  are  more 
than  usually  full  of  blood,  and  the  muscles  are  unduly  strained  because 
of  the  practical  impossibility  of  holding  the  book  squarely  before  the 
eyes.  For  a  similar  reason,  do  not  employ  the  eyes  in  a  stooping 
position  ;  it  obstructs  the  return  flow  of  blood  from  the  head  and  eyes. 
“  Carry  the  book  to  your  eyes,  and  not  your  eyes  to  the  book.” 

Eschew  the  pleasures  of  book  or  newspaper  while  riding,  unless  the 
vehicle  be  very  steady.  The  work  of  adjustment  is  greatly  increased 
by  the  shaking  of  the  letters  ;  the  eye  has  “  to  take  them  on  the  fly,” 
as  it  were,  and  it  is  very  fatiguing.  It  should  never  be  done,  even  on 
the  smoothest  railway,  if  the  eyes  are  not  perfectly  strong. 

Never  sew  on  black  at  night.  Black  absorbs  so  much  light  that 
no  ordinary  artificial  source  can  afford  enough  for  its  proper  illumi¬ 
nation. 

Whenever  the  eyes  become  tired  and  uncomfortable  stop  work  and 
rest  them  a  while.  If  you  persist  in  using  them  after  the  warning, 
you  will  be  apt  to  suffer  for  it.  If  the  fatigue  and  discomfort  be  so 
marked  as  to  amount  to  weak  sight,  seek  advice  from  some  competent 
physician,  who  will  nearly  always  put  you  in  the  way  of  obtaining  per¬ 
manent  relief. 

If  old  enough  to  wear  specs,  put  them  on  as  soon  as  you  feel  the 
need  of  them ;  which  is  to  say  when  you  catch  yourself  holding  your 
book  farther  off  in  the  day  and  abusing  the  lamp  and  the  print  at 
night. 

Plenty  of  sleep  is  important.  When  the  eyes  are  weak,  it  is  a 
necessity.  Should  you  have  children,  observe  them  while  using  their 
eyes,  and  if  they  hold  the  book  too  near  or  if  they  complain  of  them, 
examine  into  the  matter  carefully.  By  following  the  directions  given 
at  the  end  of  this  discourse,  you  can  form  some  idea  of  the  trouble 
yourself,  though  only  the  skilled  physician  can  relieve  it.  Being  am¬ 
bitious  and  studious,  do  not  urge  them  to  still  greater  tasks  for  the 


THE  CARE  OF  THE  EYES. 


21 


gratification  of  your  own  pride,  and  run  the  risk  of  irreparably  dam¬ 
aging  their  eyes  or  ruining  their  health  for  life ;  but  judiciously  curb 
their  enthusiasm,  impressing  upon  them  the  important  truth  that  the 
sound  body  is  as  necessary  as  the  cultivated  mind.  I  have  been  shocked 
at  the  folly  sometimes  exhibited  by  parents  in  this  respect. 

Glasses. 

Glasses  for  the  young,  owing  to  the  peculiar  character  or  the  serious 
nature  of  the  defects  occurring  among  them,  should  always  be  selected 
by  some  one  thoroughly  familiar  with  the  subject.  Says  a  well-known 
writer :  “  The  selection  of  glasses  for  short-sight  requires  great  care,  as 
much  harm  may  be  done  by  using  those  that  are  too  strong  or  that  are 
not  properly  fitted  to  the  eye.  In  many  cases  the  plan  of  *  trying  ’  the 
various  glasses  on  the  optician’s  counter — or,  far  worse,  in  the  peddler’s 
box — is  about  as  rational  and  safe  as  it  would  be,  in  case  of  sickness, 
to  try  the  contents  of  the  various  bottles  on  the  druggist’s  shelf  with¬ 
out  a  prescription.”  But  in  old  sight  it  is  not  so  serious  a  matter,  and 
at  the  end  I  append  a  simple  rule  for  the  selection  of  such  glasses  that 
may  prove  a  help  to  some  of  my  readers. 

Spectacles  are,  as  a  rule,  better  than  eye-glasses,  because  the  lenses 
are  kept  in  the  right  position  more  easily,  though  the  laiter  are  often 
very  handy,  especially  when  the  specs  become  mislaid,  as  they  fre¬ 
quently  do  when  not  worn  constantly.  In  such  cases,  if  expense  be 
not  an  item,  it  is  very  convenient  to  have  both.  The  frames  are  a 
matter  of  taste  only,  provided  they  fit  the  face  properly,  so  as  to  put 
the  centre  of  each  lens  opposite  each  pupil  and  the  right  distance  from 
the  efe.  Steel  frames  are  most  generally  worn,  but  for  constant  use  in 
summer  some  non-corrosive  material  is  better,  and  even  gold  is  more 
economical  in  the  long  run. 

All  glasses  are  equally  good,  provided  they  are  equally  homoge¬ 
neous  and  transparent,  the  only  difference  between  them  being  in  the 
curvature  of  their  surfaces.  “Pebbles,”  while  much  more  costly,  have 
no  special  virtues  over  glass,  other  than  greater  hardness,  and  conse¬ 
quent  less  liability  to  scratch,  and  a  little  less  weight  in  the  higher 
numbers.  Quite  often  they  are  much  inferior  to  glass,  because,  being 
cut  from  a  natural  and  peculiar  product,  fluor-spar,  they  must  be  made 
with  great  care  or  they  are  much  worse  than  glass,  and  that  caie  is  not 
always  bestowed  on  them.  Be  not  deceived  by  the  oily-tongued  venders 
of  spectacles  travelling  through  the  country.  The  truth  is  not  in  them, 
and  they  usually  charge  from  two  to  ten  prices.  If  you  are  so  unfor¬ 
tunate  as  to  need  glasses,  and  feel  equal  to  selecting  them  for  youiself, 


22 


THE  CARE  OF  THE  EYES  AND  EARS. 


buy  them  from  some  optician  or  jeweller  in  your  nearest  town  whom 
you  know  to  be  a  man  of  character. 

From  $1.50  to  $2.50  is  ample  for  the  best  glasses  in  good  steel 
frames,  and  from  $5  to  $10  in  gold,  unless  the  lenses  be  of  the  peculiar 
kind  required  in  astigmatism  or  a  combination  of  different  sorts. 

Blindness. 

In  considering  the  care  of  the  eyes  in  its  relation  to  blindness,  we 
must  deal  with  the  diseases  and  injuries  to  which  they  are  liable.  For 
a  thorough  exposition  of  the  subject  volumes  would  be  required,  such 
has  been  the  progress  in  this  branch  of  medicine ;  but  of  course  in  a 
publication  of  this  kind  it  is  only  intended  to  call  attention  to  certain 
facts  in  connection  with  them  that  ought  to  be  in  the  possession  of  every¬ 
body,  as  a  general  knowledge  of  them  would  annually  save  this  most 
precious  of  the  senses  to  very  many. 

Having  already,  in  the  first  division  of  our  subject,  dwelt  upon  the 
diseased  conditions  associated  with  near-sight  which  sometimes  cause 
the  loss  of  vision,  no  further  allusion  will  be  made  to  them. 

By  long  odds,  the  most  frequent  of  the  diseases  practically  interest¬ 
ing  to  us  is  an  inflammation  of  the  delicate  membrane  covering  the 
front  of  the  ball  and  lining  the  under  surfaces  of  the  lids,  called 
the  conjunctiva.  There  are  many  varieties  of  this,  but  the  symptoms 
common  to  all  of  them  are  redness  of  the  eyes  with  more  or  less  swell¬ 
ing  of  the  lids  and  a  discharge  of  mucus  or  matter.  The  severity  of  these 
symptoms  is  an  index  of  the  gravity  of  the  attack.  The  discharge  is 
highly  contagious ,  and,  as  the  matter  from  a  mild  case  may  excite  an 
attack  of  dangerous  severity  in  another,  the  most  scrupulous  cleanli¬ 
ness  should  be  observed,  and  no  one  should  be  permitted  to  use  the 
same  washbowl  or  towels  as  the  patient. 

A  familiar  illustration  of  this  class  of  diseases  is  the  common  “  sore 
eyes  ”  which  goes  through  the  country  every  few  years,  and  which,  it 
may  interest  you  to  know,  is  technically  known  as  catarrhal  conjunc¬ 
tivitis  or  catarrhal  ophthalmia.  It  is  generally  of  a  mild  type,  with  a 
tendency  to  recovery,  and  is,  for  the  most  part,  treated  without  the  aid 
of  a  physician,  and  usually  with  success.  But  just  here  I  must  sound 
a  note  of  warning  against  the  use  of  any  preparation  of  lead.  I  men¬ 
tion  this,  because  if  the  clear  “  watch  crystal  ”  becomes  ulcerated,  as  it 
sometimes  and  not  very  infrequently  does  in  this  disease,  the  lead  be¬ 
comes  deposited  on  the  rough  surface  of  the  ulcer  in  the  form  of  its 
insoluble  carbonate,  or  white  paint.  It  sticks  so  closely  that  it  cannot 
be  satisfactorily  removed  without  damaging  the  eye,  and  is  occasionally 


THE  CARE  OF  THE  EYES. 


23 


the  cause  of  its  total  loss.  I  have  seen  a  number  of  such  cases.  A. 
popular  old  remedy  known  as  “  Thompson’s  eye-water  ”  is  said  to  be 
one  of  these  lead  preparations,  and  should  never  on  that  account  be 
used,  as  it  cannot  be  predicted  when  these  ulcerations  may  occur. 
Any  simple  astringent,  as  alum-water,  a  teaspoonful  to  a  pint,  or  borax- 
water,  twice  as  strong,  a  few  drops  in  the  eyes  three  or  four  times 
a  day,  or  simply  bathing  the  closed  eyes  for  fifteen  or  twenty  min¬ 
utes  at  a  time  several  times  a  day  with  water  as  hot  as  can  be  borne, 
will  answer ;  but  if  the  eyes  become  decidedly  painful  and  sensitive  to 
light,  and  especially  if  the  transparent  part  appear  smoky  or  rough, 
seek  your  physician  immediately,  as  the  eye  is  in  danger  and  more 
careful  treatment  is  necessary. 

The  gravest  of  this  class  is  the  inflammation  which  comes  on  during 
the  first  week  of  life,  usually  in  the  first  three  or  four  days  afte-r  birth. 
It  is  the  most  frequent  cause  of  hopeless  blindness,  30  per  cent,  of  the 
inmates  of  the  blind  asylums  of  Great  Britain  having  lost  their  sight 
from  it,  and  in  the  United  States  82  per  cent,  of  those  blind  from  pre¬ 
ventable  disease  tracing  to  it.  And  the  pity  is  the  greater  because  it 
is  very  amenable  to  proper  treatment,  and  this  fearful  loss  of  sight 
must  therefore  be  largely  attributed  to  either  ignorance  or  neglect.  It 
can  be  easily  recognized  by  the  symptoms  common  to  the  class  men¬ 
tioned  in  the  beginning — viz.  redness  and  swelling  of  the  lids,  with  a 
discharge  of  matter,  occurring  shortly  after  birth.  In  view  of  its  dan¬ 
gerous  and,  in  bad  cases,  rapidly  destructive  character  (twenty-four  to 
forty-eight  hours  sometimes  sufficing  to  compass  the  loss  of  the  sight), 
no  time  should  be  lost  in  trying  breast-milk,  rotten  apple,  tea-leaves, 
alum*  curd,  or  other  infallible  remedies  of  the  monthly  nurse,  but  the 
physician  should  be  called  at  once.  But  do  not  sit  idly  by  doing  noth¬ 
ing  until  he  comes,  for  good  doctors  are  apt  to  be  busy  men,  and  it 
may  be  several  hours  or  longer  before  he  can  get  round,  especially  if 
it  be  in  the  country,  and  the  child’s  sight  may  be  lost  in  that  time. 
The  first  thing  to  do,  if  only  one  eye  be  affected,  is  to  try  to  prevent 
the  infection  of  the  good  one  by  matter  from  the  first,  and  the  simplest 
method  of  doing  this  is  to  seal  up  the  good  one.  I  ut  a  piece  of  soft 
clean  cotton  over  it,  and  cover  the  whole  with  sticking-plastei,  special 
care  being  taken  to  see  that  it  is  securely  glued  down  on  the  dangerous 
side.  For  the  same  reason  the  child  should,  as  far  as  possible,  lie  on 
the  affected  side  and  the  hands  should  be  secured.  But  both  eyes  are 
nearly  always  involved  from  the  beginning.  As  cleanliness  is  the  most 
important  part  of  the  treatment,  set  to  work  to  cleanse,  and  keep  the  eyes 
clean,  repeating  the  washing  as  often  as  every  half  hour  if  necessary . 


24 


THE  CARE  OF  THE  EYES  AND  EARS. 


Separating  with,  the  thumb  and  forefinger  of  the  left  hand  the  lids  of 
the  lower  eye  (the  child  lying  on  his  side),  let  a  stream  of  the  borax-  or 
alum- water,  mentioned  above,  from  a  sponge  or  cloth  saturated  with  it 
run  between  them  upon  a  folded  towel  previously  placed  under  that 
side  of  the  head,  and  repeat  until  the  matter  is  all  washed  out.  After 
the  doctor  comes  attend  carefully  to  his  directions,  and  carry  them  out 
to  the  letter  day  and  night ,  for  in  the  bad  cases  of  this  disease  eternal 
vigilance  is  the  price  of  sight. 

In  all  those  eye  troubles  characterized  by  a  dread  of  light,  watering 
of  the  eyes,  particularly  on  exposure,  and  pain,  especially  if  it  extend 
to  the  brow,  temple,  side  of  nose,  and  perhaps  run  up  into  the  head, 
very  important  structures  are  almost  surely  involved  and  medical  aid 
should  be  obtained  without  delay.  Irreparable  damage  may  result  from 
waiting  only  a  few  days. 

Elderly  persons  who  observe  rings  or  rainbows  around  the  lamp, 
and  who  suffer  from  occasional  attacks  of  dimness  of  sight,  are  threat¬ 
ened  with  a  disease  known  to  oculists  as  glaucoma.  Should  the  dim¬ 
ness  persist  for  twenty-four  hours,  especially  if  accompanied  by  pain 
in  the  eye  or  head,  let  not  another  day  pass  without  obtaining  skilled 
advice.  The  results  of  prompt  treatment  are  among  the  most  brilliant 
in  surgery ;  absolute  and  hopeless  blindness,  often  accompanied  by 
great  pain,  is  the  consequence  of  neglect. 

Cataract  is  the  most  common  cause  of  curable  blindness.  It  is  sim¬ 
ply  a  cloudiness  or  opacity  of  the  crystalline  lens,  so  that  cataract  is 
in  the  eye,  not  on  it,  as  we  often  hear  it  said.  It  may  occur  at  any 
time  of  life,  but  nearly  always  at  the  two  extremes,  being  often  con¬ 
genital,  but  usually  one  of  the  results  of  age.  A  gradual  failure  of 
sight,  presenting  the  peculiarity  of  being  better  in  a  dim  than  in  a 
bright  light,  at  twilight  than  in  the  middle  of  the  day,  is  very  sugges¬ 
tive — quite  characteristic  indeed  of  certain  partial  cataracts  occurring 
in  the  young ;  but  the  nature  of  the  disease  is  rendered  certain  by  the 
appearance  of  the  pupil,  which,  instead  of  being  black  as  in  health,  is 
gray  or  white.  The  pupils  of  all  old  persons  are  somewhat  grayish, 
from  the  natural  hardening  of  the  lens,  but  their  sight  is  good.  The 
blindness  is  relieved  by  the  removal,  by  a  delicate  surgical  operation, 
of  the  opaque  lens ;  and  such  has  been  the  progress  in  this  branch  of 
medicine  that,  taking  the  average,  over  90  per  cent,  are  restored  to 
sight.  It  is  peculiarly  important  that  the  cataract  of  infancy  and 
childhood  should  be  removed  during  that  period  of  life,  because  by 
obstructing  the  light  it  prevents  the  development  of  the  nervous  appa¬ 
ratus  of  the  eye  from  want  of  exercise.  Neglect  to  have  it  done  is  the 


THE  CARE  OF  THE  EYES. 


25 


more  inexcusable  on  the  part  of  parents  because  the  operation  is  not  a 
difficult  one,  and  is  not  often  followed  by  bad  results. 

Tobacco  Amaurosis  is  a  form  of  blindness  that  results  from  the  ex¬ 
cessive  use  of  tobacco.  It  is  an  affection  of  the  optic  nerve,  and  there 
are  no  visible  changes  in  the  eye,  the  only  symptom  being  a  gradual 
failure  of  sight.  Abandoning  the  habit,  sight  is  almost  sure  to  return 
under  a  tonic  treatment. 

Floating  Specks — or  Muscce  Volitantes,  as  they  are  technically  called 
— are  small  spots  of  various  shapes,  or  more  or  less  translucent  bodies, 
singly  or  in  strings  like  beads,  which  are  seen  floating  about  in  the 
field  of  vision  upon  looking  at  a  bright  surface.  They  are  merely 
shadows  cast  upon  the  retina  by  minute  opacities  in  the  vitreous  humor, 
and,  sight  being  good  in  other  respects,  they  mean  nothing.  Any  one 
can  see  them  by  looking  at  the  sky  or  a  white  wall  through  a  pin-hole 
in  a  card. 

Color-Blindness  is  a  peculiar  affection  which,  while  it  may  be  caused 
by  disease,  is  generally  congenital.  Sight  for  ordinary  purposes  is  of 
normal  acuteness,  but  certain  colors,  most  commonly  red  or  green,  can¬ 
not  be  correctly  distinguished.  It  is  very  much  more  frequent  among 
men  than  women  (3  or  4  per  cent,  to  much  less  than  1  per  cent.). 
Practically,  it  is  interesting  and  important  in  its  relation  to  the 
employees  of  railways  and  steamboats,  who  are  governed  by  colored 
signals.  The  question  of  life  and  death  being  involved  in  the  correct 
reading  of  the  signals,  all  such  employees  should  be  carefully  tested  in 
this  respect  before  being  taken  on. 

Accidents  and  Injuries. — Certain  wandering  denizens  of  the  air,  such 
as  moths,  cinders,  gnats,  etc.,  frequently  find  their  way  into  the  eyes, 
and  few  of  us  have  not  felt  “  what  small  things  are  boisterous  there.” 
Entering  with  comparatively  little  force,  they  are  not  imbedded  in  the 
tissues,  but  are  usually  found  lying  between  the  ball  and  one  or  the 
other  lid,  generally  the  upper.  This  being  so,  they  are  sometimes  very 
easily  removed  by  pulling  down  the  upper  lid  over  the  lower,  so  as  to 
wipe  the  under  surface  of  the  former  by  the  lashes  of  the  latter.  Fail¬ 
ing  in  this,  it  is  not  worth  while  to  waste  time  on  flaxseed,  the  popular 
remedy — which  acts,  if  at  all,  by  getting  between  the  lid  and  ball,  lifting 
it  off,  thereby  giving  the  tears  a  better  chance  to  wash  the  foreign  body 
out — as  prompt  relief  can  nearly  always  be  secured  by  a  little  simple 
manipulation  on  the  part  of  a  friend.  It  is  done  in  this  way  :  Place 
the  point  of  an  ordinary  lead-pencil  or  other  small  rod  horizontally  on 
the  upper  lid  about  half  an  inch  from  its  edge;  grasp  the  lashes  thinly 
with  the  other  hand,  hold  the  pencil  steady,  tell  the  patient  to  “  look 


26 


THE  CARE  OF  THE  EYES  AND  EARS. 


down,”  and  just  as  he  does  so  turn  the  lid  quickly  over  the  pencil,  and, 
nine  times  out  of  ten,  you  will  find  the  mote  or  cinder  sticking  to 
it.  Having  found  it,  wipe  it  gently  off  with  either  a  handkerchief,  a 
twisted  piece  of  paper,  or,  best  of  all,  a  small  soft  brush  made  by  wrap¬ 
ping  a  little  cotton  around  the  end  of  a  match. 

Workers  in  metal  and  stone  are  liable  to  more  serious  invasions  by 
flying  fragments  of  the  material  in  which  they  work.  These  minute 
pieces  of  steel  or  stone  fly  off  with  so  much  force  that  very  often  they 
are  imbedded  in  the  clear  front  of  the  ball.  An  attempt  may  be  made 
to  remove  them  with  the  brush  just  "spoken  of  or  with  a  bluntly  and 
smoothly-pointed  stick  of  soft  wood ;  but  if  it  is  not  easily  and  quickly 
done  a  more  skilful  hand  should  be  sought,  as  repeated  efforts  might 
seriously  damage  the  transparent  cornea.  Prevention  being  better  than 
cure,  such  artisans  should  always  wear  while  at  work  strong  eye-pro¬ 
tectors. 

Quite  often  these  foreign  bodies  are  of  sufficient  size,  and  strike  the 
eye  with  force  enough,  to  penetrate  its  walls  and  let  out  some  of  its 
humors,  the  most  common  being  fragments  of  gun-caps  and  splinters 
of  wood  which  fly  up  in  chopping.  Injuries  of  this  character  are  of 
such  serious  import  that  no  intelligent  person  would  fail  to  shift,  as  soon 
as  possible,  the  responsibility  on  his  medical  attendant.  There  is  some¬ 
times  in  these  cases  a  special  reason  for  seeking  his  help.  If  the  cut 
through  the  coats  lie  in  what  is  called  the  “  dangerous  region,”  which 
is  a  belt  of  the  white  of  the  eye  about  one-eighth  of  an  inch  wide 
lying  immediately  around  the  colored  part,  and  especially  if  the  mis¬ 
sile  be  still  within  the  ball,  there  is  great  danger  of  exciting  in  the 
sound  eye  the  dreaded  sympathetic  disease,  which,  when  once  estab¬ 
lished,  is  practically  hopeless,  causing  nearly  always  complete  and  ir¬ 
remediable  loss  of  sight. 

Not  seldom  the  eyes  are  injured  by  caustics  of  one  kind  or  another, 
the  most  frequent  being  unslaked  lime  in  fresh  mortar.  In  such  cases 
a  little  castor  or  sweet  oil  should  be  immediately  dropped  into  the  eye, 
and  then  the  lime  washed  out  with  water. 

i  • 

Tests  of  Vision. 

In  the  types  below  numbered  1  and  XX.  we  have  the  tests  respect¬ 
ively  for  near  and  distant  vision.  The  perfect  eye  should  distinguish 
No.  1  at  one  foot,  and  No.  XX.  at  twenty  feet,  the  retinal  images  of 
the  two  being  of  the  same  size  at  those  distances. 

The  power  of  accommodation  being  normal,  No.  1  should  be  read, 
with  an  effort,  as  near  as  three  inches  at  the  age  of  ten ;  four  inches  at 


THE  CARE  OF  THE  EYES. 


27 


twenty ;  five  and  one-half  at  thirty ;  and  eight  at  forty.  When  this 
“  near  Point  ”  recedes  beyond  nine  inches,  which  it  usually  does  about 
forty-five,  it  is  time  to  put  on  spectacles.  The  rule  for  their  selection 
is  simply,  in  a  few  words,  to  put  on  a  convex  glass  strong  enough  to 
bring  it  up  again  to  nine  inches.  If  nearer  than  that,  the  glass  is  apt 
to  be  uncomfortably  strong,  while  if  it  is  not  brought  within  ten  inches 
it  is  not  likely  to  afford  complete  relief,  especially  at  night,  when  a 
rather  stronger  lens  is  needed  than  will  answer  under  the  brilliant 
illumination  of  daylight. 

A  person  who  can  read  No.  XX.  at  twenty  feet,  and  cannot  read 
No.  1  as  near  as  he  ought  at  his  age,  is  almost  certainly  moderately' 
far-sighted. 

One  who  can  read  No.  1  as  he  ought,  but  cannot  make  out  No.  XX., 
is  moderately  near-sighted.  If  No.  1  be  very  distinct  at  a  nearer  point 
than  one  foot  while  distant  vision  is  very  bad,  the  person  has  myopia 
of  a  higher  degree. 

One  who  can  distinguish  neither  at  the  proper  distance  is  either 
astigmatic  or  very  far-sighted — or  over-sighted,  as  now  appears  to  be 
the  better  term — or  very  near-sighted.  In  astigmatism  and  far-sight 
both  near  and  distant  vision  are  relatively  much  the  same,  equally 
good  or  bad.  In  high  degrees  of  near-sight  distant  vision  is  propor¬ 
tionally  very  much  worse. 

No.  1.* — Diamond. 

The  place  of  our  retreat  was  in  a  little  neighbourhood,  consisting  of  farmers,  who  tilled  their  own 
grounds,  and  were  equal  strangers  to  opulence  and  poverty.  As  they  had  almost  all  the  conveniences 
of  life  within  themselves,  they  seldom  visited  towns  or  cities  in  search  of  superfluities.  Remote  from  the 
polite,  they  still  retained  the  primaeval  simplicity  of  manners  ;  and  frugal  by  habit,  they  scarce  knew 
that  temperance  was  a  virtue.  They  wrought  with  cheerfulness  on  days  of  labour,  but  observed  festi¬ 
vals  as  intervals  of  idleness  and  pleasure.  They  kept  up  the  Christmas  carol,  sent  true-love  knots  on 
Valentine  morning,  ate  pancakes  on  Shrove-tide,  showed  their  wit  on  the  first  of  April,  and  religiously 
cracked  nuts  on  Michaelmaseve.  Being  apprised  of  our  approach,  the  whole  neighbourhood  came  out 
to  meet  their  minister,  dressed  in  their  fine  clothes,  and  preceded  by  a  pipe  and  tabor ;  a  feast  also  was 
provided  for  our  reception,  at  which  we  sat  cheerfully  down  ;  and  what  the  conversation  wanted  in  wit, 


XX. 


-Fi 

*  This  type  is  really  1£  and  should  he  read  by  the  normal  eye  as  far  as  one  foot 
and  a  half,  but  practically  it  will  answer  very  well. 


THE  CARE  OF  THE  EARS. 


Considering  man  merely  as  a  constituent  element  of  the  community, 
deafness  is  not  so  serious  as  blindness ;  but  in  its  relation  to  the  happi¬ 
ness  of  the  unfortunate  individual  it  is  generally  regarded  by  those 
having  opportunities  of  observation  as  the  worse  of  the  two. 

The  deaf  never  receive  the  sympathetic  consideration  universally 
accorded  to  the  blind  on  account  of  their  physical  helplessness,  but, 
on  the  contrary,  are  often  treated  with  impatience,  if  not  with  positive 
harshness.  In  addition,  they  are  frequently  harassed  by  subjective  sen¬ 
sations — noises  of  various  kinds,  “  so  exquisitely  distressing,”  says 
Politzer,  the  greatest  authority  on  the  ear,  “  as  to  undermine  often 
both  the  physical  and  moral  powers  of  the  individual,  and  in  some 
cases  even  to  lead  to  suicide.”  Their  dispositions  suffer  in  consequence, 
and  they  are  apt  to  become  sensitive,  suspicious,  and  reserved.  This 
is  peculiarly  the  case  with  those  wrho  lose  their  hearing  in  child¬ 
hood  while  their  moral  natures  are  even  more  soft  and  pliant  than  their 
physical  bodies.  So  deafness  is  very  much  more  of  an  affliction  than 
those  with  good  hearing  are  prepared  to  admit. 

The  ear  is  made  up  of  three  divisions :  a  sound-collecting,  a  sound- 
transmitting,  and  a  sound-receiving  apparatus, 

With  the  first  of  these  every  one  is  familiar  in  the  peculiarly-shaped 
external  ear  or  auricle.  The  waves  of  sound,  having  been  collected  by 
this,  traverse  the  auditory  canal,  which  is  about  an  inch  and  a  quarter 
long,  and  fall  upon  a  delicate  membrane  stretched  tightly  across  the 
inner  end  of  it.  This,  in  ordinary  conversation,  is  often  spoken  of  as 
the  “  drum  of  the  ear,”  but  it  is,  in  fact,  only  the  drum-/mad,  or  tym¬ 
panic  membrane,  the  drum  being  a  cavity  with  other  parts  in  addition. 
Fastened  to  the  inner  surface  of  this  drumhead  is  the  first  of  a  chain 
of  three  tiny  bones,  called  the  hammer,  the  anvil,  and  the  stirrup,  from 
their  resemblance  to  those  objects,  united,  as  other  bones,  by  joints 
(which  sometimes,  like  them,  become  stiff)  that  extend  across  the 
drum-cavity.  The  end  of  tl\e  last  one,  the  foot  of  the  stirrup,  fits  into 
an  oval  hole  in  the  inner  bony  wall  of  the  drum,  which  is  the  outer 
wrall  of  the  labyrinth.  It  lies  immediately  in  contact  with  the  fluid 
28 


THE  CARE  OF  THE  EARS. 


29 


filling  the  labyrinth  or  inner  ear,  the  sound-receiving  apparatus,  in 
which  fluid  the  ends  of  the  nerve  of  hearing  are  bathed. 

The  waves  of  sound  striking  against  the  taut  drumhead,  it  is  thrown 
into  vibrations,  and  these  vibrations  are  transmitted  through  the  chain 
of  bones  to  the  fluid,  and  through  that  to  the  nerve.  This,  in  brief,  is 
the  mechanism  of  hearing. 

Connecting  the  drum  with  the  throat  is  a  small  and  crooked  tube, 
about  an  inch  and  a  half  long,  called  the  Eustachian  tube.  This  tube, 
as  well  as  the  drum  itself,  is  lined  with  the  same  mucous  membrane  that 
covers  the  throat.  Indeed,  the  drum  is,  anatomically  considered,  an 
offshoot  from  the  throat.  Such  being  the  case,  we  would  naturally 
expect  the  drum  to  suffer  with  the  throat  in  disease.  And  the  facts 
bear  out  the  anticipation.  Fully  three-fourths  of  all  cases  of  deafness 
are  attributable  to  affections  of  the  drum  or  conducting  apparatus  that  are 
almost  invariably  associated  with  similar  disease  in  the  throat.  Although 
persons  hard  of  hearing  may  not  complain  of  the  throat,  it  very  rarely 
happens  that  trouble  cannot  be  found  there  if  looked  for.  When  we 
remember  how  exceedingly  common  colds  and  sore  throats  are,  bearing 
in  mind  that  the  back  part  of  the  nose  is  a  part  of  the  upper  throat, 
into  which  the  Eustachian  tubes  enter,  it  is  very  evident  why  this  form 
of  deafness  is  so  frequent. 

Inflammations  of  mucous  membranes  are  always  accompanied  by 
swelling  or  a  discharge  of  mucus,  generally  both  ;  and,  keeping  these 
facts  in  view,  it  is  very  easy  to  understand  how  these  troubles  cause  deaf¬ 
ness.  The  purpose  of  the  Eustachian  tube  is  to  keep  the  drum  full  of  air, 
and  Nature  has  provided  that  it  shall  open  every  time  we  swallow  or 
yawn,  so  that  the  air  may  enter  easily  if  there  be  need  for  it.  T  ou 
have  no  doubt  often  felt  the  air  rush  into  the  ears  when  blowing  your 
nose  violently,  and  felt  a  roaring  in  them  when  gaping  widely. 

Sometimes  in  fresh  colds  the  membrane  surrounding  the  mouth  of 
the  tube  becomes  so  swollen  as  to  close  it,  or  it  becomes  stopped  by  a 
plug  of  mucus,  and  then  deafness  results,  because  the  air  in  the  drum 
is  partially  absorbed  and  cannot  be  replaced.  In  these  cases,  when 
the  tubes  are  opened,  the  restoration  of  hearing  is  often  magically  in¬ 
stantaneous.  It  occasionally  happens  that  hearing  suddenly  returns  of 
itself  with  a  sudden  snap.  The  swelling,  however,  is  not  always,  or  even 
generally,  restricted  to  the  mouth  of  the  Eustachian  tube,  but  involved 
the  length  of  the  tube  and  the  drum  itself.  Of  course  swelling  in  these 
situations,  and  especially  the  presence  of  a  viscid  fluid  in  so  delicate  an 
instrument  as  the  drum,  must  seriously  interfere  with  its  proper  work¬ 
ing.  In  the  acute  forms  of  these  troubles  relief  can  generally  be  af- 


30 


THE  CARE  OF  THE  EYES  AND  EARS. 


forded,  but  when  they  are  allowed  to  become  chronic  the  changes  in 
the  tube  and  drum  often  assume  a  permanent  character,  and  complete 
restoration  to  hearing  is  then  impossible. 

The  moral  to  be  drawn  from  this  is,  that  deafness  should  be  treated 
promptly  in  the  beginning,  before  irreparable  damage  is  done.  This  is 
peculiarly  true  of  these  troubles  occurring  in  children,  as  they  are  then 
exceedingly  amenable  to  treatment,  while  their  neglect  is  liable  to 
eventuate  in  permanent  impairment  of  hearing. 

In  this  connection  it  is  proper  to  make  a  suggestion  to  teachers  in 
regard  to  deaf  children.  They  are  necessarily  at  a  great  disadvantage 
on  account  of  their  infirmity,  and  are  often  accused  of  stupidity  or  in¬ 
attention  when  the  truth  is  they  cannot  hear.  So,  whenever  there  is 
any  reason  to  suspect  such  a  thing,  carefully  test  the  hearing  by  con¬ 
versation  across  the  room  with  the  child’s  back  to  you,  beginning  with 
a  whisper  and  gradually  raising  the  voice,  making  him  repeat  each 
word  after  you.  Ascertaining  those  who  are  deaf,  seat  them  nearest  to 
you,  and  be  patient  with  them,  remembering  that  one  of  the  frequent 
results  of  deafness  and  its  accompaniments  is  an  injurious  effect  upon 
the  disposition,  and  that  probably  under  similar  circumstances  you 
would  not  be  amiable. 

Earache,  a  familiar  enemy  in  most  families  with  children,  is  generally 
due  at  first  to  a  congestion  of  the  lining  membrane  of  the  drum,  and 
can  usually  be  promptly  relieved  by  heat .  The  heat  may  be  applied  in 
various  ways — by  cloths  wrung  out  of  hot  water,  raw  cotton  heated  by 
application  to  the  surface  of  a  tin  vessel  filled  with  boiling  water,  flan¬ 
nel  bags  of  salt  or  sand  heated  in  an  oven,  or,  best  of  all,  a  steady, 
gentle  stream  of  wTater,  as  hot  as  it  can  be  borne,  for  twenty  or  thirty  min¬ 
utes,  into  the  aural  canal.  Sometimes  simply  breathing  into  the  ear  will 
give  relief.  The  old-fashioned  remedy  of  a  boiled  onion  is  not  a  bad 
one,  but  never  apply  poultices  to  the  ear :  they  are  liable,  while  giving 
temporary  ease,  to  do  eventual  injury.  Abjure  spirits  of  camphor,  ker¬ 
osene,  and  such  remedies  ;  they  do  no  good,  and  may  do  harm.  If  heat 
fails,  call  in  your  physician,  and  he  may  try  the  celebrated  new  remedy 
cocaine,  which  sometimes  succeeds  in  relieving  pain  in  the  ear,  though 
it  often  fails,  being  by  no  means  so  satisfactory  as  in  eye  troubles. 

The  earache  being  neglected,  and  the  congestion  of  the  lining  mem¬ 
brane  of  the  drum  going  on  to  inflammation,  mucus  is  jmired  out  just 
as  it  is  from  the  nose  in  a  fresh  cold.  The  Eustachian  tube  being  also 
swollen,  the  mucus  cannot  escape  by  that,  which  is  the  only  avenue, 
and  so  it  accumulates,  causing  fearful  pain,  until  by  pressure  upon  the 
delicate  drumhead  it  brings  about  its  ulceration  and  perforation,  allow- 


THE  CARE  OF  THE  EARS. 


31 


ing  the  mucus,  which  soon  changes  to  matter,  to  find  its  way  out 
through  the  external  canal. 

Otorrhcea — which  means  a  running  from  the  ear — is  the  technical 
name  given  to  this  state  of  things,  and  the  cause  of  it,  above  set  forth 
in  detail,  is  commonly  called  “  a  rising  in  the  head.”  You  will  note 
that  a  hole  in  the  drumhead  is  one  of  its  constant  features.  Notwith¬ 
standing  the  great  damage  to  the  ear,  it  is,  owing  to  its  common  occur¬ 
rence  and  to  the  fact  that  some  cases  do  get  well  (that  is,  the  running 
stops)  without  any  special  treatment,  often  looked  upon  by  parents,  and 
occasionally  by  physicians  who  have  not  quite  kept  up  with  the  times, 
as  a  trifling  matter,  their  advice  in  such  cases  being,  “  Let  it  alone  and 
he  will  outgrow  it.”  But  it  is  by  no  means  a  trifling  matter.  If  neglected, 
the  pus  lying  in  the  canal  decomposes  and  becomes  very  offensive,  mak¬ 
ing  the  poor  child  a  stench  in  the  nostrils  of  his  associates.  To  illus¬ 
trate  to  what  extent  this  neglect  has  been  carried  in  some  few  instances, 
it  may  be  mentioned  that  living  maggots  have  been  found  in  the  ear. 
Another  consequence  of  a  want  of  attention  is  much  greater  deafness 
than  would  have  followed  prompt  treatment.  But  the  evil  effects  of 
neglect  of  a  running  from  the  ear  do  not  always  end  here.  The  dis¬ 
ease  may  extend  to  the  bone,  and  thence  to  the  brain,  the  dividing-wall 
between  the  ear  and  the  brain  being  exceedingly  thin,  and  cause  death. 
The  wonder  is  that  more  fatal  cases  are  not  recorded,  and,  as  it  is,  those 
who  are  not  familiar  with  the  subject  would  be  shocked  to  know  how 
many  die  from  this  cause.  It  need  not  be  said,  therefore,  that  they 
should  always  receive  medical  attention.  The  treatment  is  simple  and 
the  services  of  a  specialist  are  not  usually  required,  any  well-informed 
physician  being  competent  to  undertake  most  of  them.  There  cer¬ 
tainly  can  be  no  excuse  for  not  keeping  them  clean  by  daily  syringing 
out  the  ear  with  warm  water.  All  applications  to  the  ear  should  be 
warm. 

Wax,  or  a  compound  commonly  called  by  that  name,  is  a  natural  secre¬ 
tion  of  the  walls  of  the  aural  canal  of  a  yellowish-brown  color  and  peculiar 
odor,  the  purpose  of  which,  it  is  supposed,  is  to  repel  wandering  insects. 
Quite  often  it  accumulates  until,  by  blocking  up  the  canal,  it  causes 
deafness ;  which,  by  the  way,  generally  comes  on  with  more  or  less 
suddenness.  It  can  generally  be  seen  as  a  dark  mass  by  an  inspection 
before  an  open  window,  the  auricle  being  pulled  upward  and  backward 
to  straighten  the  canal.  It  should  always  be  removed,  as  its  presence 
in  a  hardened  mass  is  apt  to  prove  injurious.  Fill  the  ear  nightly  with 
warm  soda-water  (a  teaspoonful  of  cooking  soda  to  a  tumbler),  letting 
it  remain  fifteen  or  twenty  minutes  for  three  or  four  nights,  to  soften 


32 


THE  CAKE  OF  THE  EYES  AND  EARS. 


the  wax,  and  then  syringe  somewhat  forcibly  with  warm  water.  But, 
unfortunately,  this  syringing  of  the  ear  is  not  as  simple  as  it  sounds, 
nor  is  it  entirely  safe  in  inexperienced  hands ;  so  it  is  best  to  go  to  your 
doctor  at  once,  especially  as  other  changes  are  often  associated  with  this 
accumulation  which  will  need  attention. 

Insects  of  various  kinds  frequently  get  into  the  ear,  and  by 
scratching  the  exquisitely  sensitive  drumhead  with  their  claws  often 
cause  frightful  pain  and  the  most  terrific  noises.  (I  was  called  from 
my  bed  early  this  morning  to  relieve  marked  distress  occasioned  by  so 
harmless  a  thing  as  a  common  house-fly.)  When  the  presence  of  an 
insect  is  suspected,  the  ear  should  be  filled  with  warm  water,  which  will 
either  run  him  out  or  drown  him. 

Foreign  bodies ,  such  as  beads,  peas,  cherry-stones,  etc.,  in  the  aural 
canal  “  should  never  be  touched  by  incompetent  hands.”  If  they  can¬ 
not  be  shaken  out  by  jarring  the  head,  the  aid  of  an  expert  should 
be  obtained,  as  a  number  have  lost  their  lives  from  badly-directed 
attempts  to  remove  them. 

Injuries  to  the  ear,  through  rupture  of  the  drumhead,  sometimes 
result  from  the  violent  concussion  due  to  a  loud  explosion,  as  of  a  large 
cannon.  Now  and  then  it  is  a  consequence  of  a  concussion  of  a  more 
homely  and  every-day  character — to  wit,  a  box  on  the  ear.  As  “  there 
are  a  few  well-authenticated  instances  of  death  having  occurred  from 
this  barbarous  custom,”  it  is  superfluous  to  add  that  it  is  “  more  honored 
in  the  breach  than  in  the  observance.”  The  drum  is  sometimes  injured 
by  sharp  instruments,  such  as  hairpins,  knitting-needles,  toothpicks, 
etc.,  and  my  reader  is  warned  against  scratching  the  ear  in  any  such 
way.  Never  put  any  instrument  in  the  ear  except  your  finger ;  you 
cannot  get  that  deep  enough  to  do  any  harm. 

Before  concluding,  I  must  again  direct  attention  to  the  importance 
of  looking  after  those  every-day  troubles  earache  and  “  rising  in  the 
head.”  To  their  neglect  are  attributable  a  great  many  cases  of  incur¬ 
able  deafness,  and  some  of  death. 


